Cincinnati Research in Outcomes and Safety in Surgery (CROSS) Research Group, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Division of Surgical Oncology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Ann Surg Oncol. 2024 Oct;31(11):7641-7653. doi: 10.1245/s10434-024-15811-x. Epub 2024 Jul 20.
The Choosing Wisely (CW) campaign recommended de-implementation of surgical management of axillary nodes in specified patients. This study aimed to assess trends in the application of CW guidelines for lymph node (LN) surgery in males with breast cancer.
The National Cancer Database was queried for males diagnosed with breast cancer from 2017 to 2020. Patients were categorized into two cohorts based on CW criteria. Cohort 1 included all T1-2, clinically node-negative patients who underwent breast-conserving therapy and with ≤ 2 positive nodes, and Cohort 2 included all T1-2, node-negative, hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative patients aged ≥ 70 years. In Cohort 1, patients who underwent sentinel LN biopsy (SLNB) alone were compared with axillary LN dissection (ALND) or no LN surgery, while in Cohort 2, patients who underwent LN surgery were compared with those with no LN surgery.
Of 617 patients who met the criteria for Cohort 1, 73.1% underwent SLNB alone compared with ALND (11.8%) or no LN surgery (15.1%). Those who received SLNB alone were younger (65 vs. 68 vs. 73 years; p < 0.001). The annual proportion of males who underwent SLNB alone remained stable from 2017 to 2020. Overall, 1565 patients met the criteria for Cohort 2, and 84.9% received LN surgery. LN surgery was omitted in older patients (81 vs. 77; p < 0.001). The proportion of elderly males with early-stage breast cancer who underwent LN surgery increased from 2017 to 2020.
This study demonstrates that CW recommendations are not being routinely applied to males. These findings reinforce the need for additional studies and subsequent recommendations for optimal application of axillary surgery de-implementation for males diagnosed with breast cancer.
明智选择（Choosing Wisely，CW）运动建议在特定患者中取消腋窝淋巴结的手术治疗。本研究旨在评估 CW 指南在男性乳腺癌患者中应用于淋巴结（LN）手术的趋势。
从 2017 年至 2020 年，国家癌症数据库中检索男性乳腺癌患者的诊断数据。根据 CW 标准，患者分为两个队列。队列 1 包括所有 T1-2、临床淋巴结阴性、接受保乳治疗且≤2 个阳性淋巴结的患者，队列 2 包括所有 T1-2、淋巴结阴性、激素受体阳性、人表皮生长因子受体 2（HER2）阴性且年龄≥70 岁的患者。在队列 1 中，比较仅行前哨淋巴结活检（SLNB）与腋窝淋巴结清扫（ALND）或不进行淋巴结手术的患者，而在队列 2 中，比较行淋巴结手术与不进行淋巴结手术的患者。
在符合队列 1 标准的 617 名患者中，73.1%接受了单独的 SLNB，而接受 ALND（11.8%）或不进行淋巴结手术（15.1%）的患者比例较低。接受 SLNB 治疗的患者年龄较轻（65 岁比 68 岁比 73 岁；p<0.001）。2017 年至 2020 年，接受 SLNB 治疗的男性比例保持稳定。总体而言，1565 名患者符合队列 2 的标准，其中 84.9%接受了淋巴结手术。在老年患者中省略了淋巴结手术（81 岁比 77 岁；p<0.001）。2017 年至 2020 年，患有早期乳腺癌的老年男性接受淋巴结手术的比例有所增加。
本研究表明，CW 建议并未常规应用于男性。这些发现强调需要进一步研究，并为男性乳腺癌患者优化腋窝手术实施提供后续建议。
